Yesterday in the Vancouver Sun (front page) is a report by Pamela Fayerman after her talking to the daughter of Rosemarie Timer. Rosemarie fell while in hospital and died from a head injury which Jennifer thought could have been prevented.
Deaths from falls in hospitals happen often but no one takes the deaths seriously, especially the media. I am sure there should be a criminal charge of endangerment or homocide for this careless behaviour on part of hospital staff but I suspect it is not in the public interest to arrest those that are responsible. It would be against the public interest for us to know that there were 456 preventable deaths (BC Coroner) from falls last year 2013. The public might demand criminal charges or worse yet patients would refuse to be admitted to hospitals in the first instance.
I am surprised that the report was even published. It must have fallen through the cracks of the editorial staff at the Sun. When Randy Michael Walker died I had to have a court order to access him at his death in the ICU and the media didn't comment on that, nor anyone else. I also had complaints about his care. (The media reads all Supreme Court Orders.)
Again, if anyone wants a full version of my blog let me know and I will have Blog2Print print the contents and mail it to you. The Blog2Print paper book edition (its cost) is $50.00.
Friday, June 27, 2014
Tuesday, June 24, 2014
23 June 2014
I was hoping my grieving would be getter lesser but it hasn't. I see Randy wherever I go or not go. I did not know he was going to die. He has had pneumonia many times and he always recovered.
Yesterday I went to the Oakridge Senior's Senior for breakfast and at 10:30 NIDUS was scheduled to give a talk about representation agreements. The young women made it sound like it was some sort of answer to some sort of problem. I told the group of my experience with Randy's representation agreements and the failure of Vancouver Coastal Health to honour them.
I got upset when the girl said that representation agreements could ONLY be registered online for $25.00. I asked her could they be filed manually. No. Only by computer. I said that most of her target audience (us oldies) are uncomfortable with computers. And on top of it if you want to register a representation agreement a person would have to have a credit card for the $25.00 fee. I do not understand why there is a fee when the United Way is funding the project and its staff of three.
When I got home I had to face Misey who had a serious eye infection, the size of a golf ball. So with difficulty I had to arrange for a ride to the vet. $32.00 it cost for the eye drops. I had a hard time gettng Misey to walk home as she walks three hundred steps then sits down for a rest. Finally and slowly we got home and now she refuses to leave the apartment. She is on strike. I think she is afraid of being abandoned. Just like me having to abandon Randy because VCH deemed that was best for Randy. GPC bans people because they do not want anyone to see bedsores on patients which Randy had one when he died at VCH. GPC tried to hide it. Maybe he died of blood poisoning rather than pneumonia. I do not know and I still haven't got the autopsy yet. I hope that the pathologist wasn't too busy to recognize a wound the size of a toonie.
Yesterday I went to the Oakridge Senior's Senior for breakfast and at 10:30 NIDUS was scheduled to give a talk about representation agreements. The young women made it sound like it was some sort of answer to some sort of problem. I told the group of my experience with Randy's representation agreements and the failure of Vancouver Coastal Health to honour them.
I got upset when the girl said that representation agreements could ONLY be registered online for $25.00. I asked her could they be filed manually. No. Only by computer. I said that most of her target audience (us oldies) are uncomfortable with computers. And on top of it if you want to register a representation agreement a person would have to have a credit card for the $25.00 fee. I do not understand why there is a fee when the United Way is funding the project and its staff of three.
When I got home I had to face Misey who had a serious eye infection, the size of a golf ball. So with difficulty I had to arrange for a ride to the vet. $32.00 it cost for the eye drops. I had a hard time gettng Misey to walk home as she walks three hundred steps then sits down for a rest. Finally and slowly we got home and now she refuses to leave the apartment. She is on strike. I think she is afraid of being abandoned. Just like me having to abandon Randy because VCH deemed that was best for Randy. GPC bans people because they do not want anyone to see bedsores on patients which Randy had one when he died at VCH. GPC tried to hide it. Maybe he died of blood poisoning rather than pneumonia. I do not know and I still haven't got the autopsy yet. I hope that the pathologist wasn't too busy to recognize a wound the size of a toonie.
GPC:Hospital for special care.? Quality of Life okay for most.
New York Times June 23 2014
NEW BRITAIN, CONN. — Propped up in a hospital bed, a 75-year-old man with amyotrophic lateral sclerosis, or Lou Gehrig’s disease, must make an agonizing decision. Should he keep struggling until the illness inevitably kills him, dependent on a ventilator, unable to walk or eat or move? Or should he choose a day and a time to have the ventilator disconnected, and die?
The man, who asked not to be identified to protect his privacy, was a patient at the Hospital for Special Care here, one of 400 long-term acute care hospitals in the United States. These are no ordinary hospitals: Critically ill patients, sometimes unresponsive or in comas, may live here for months, even years, sustained by respirators and feeding tubes. Some, especially those recovering from accidents, eventually will leave. Others will be here for the rest of their lives.
These facilities often are tucked out of sight, and even many doctors do not know they exist. This one sits on the edge of a decaying industrial town.
“People don’t want to think about us,” said Dr. Paul Scalise, chief of medicine at the Hospital for Special Care. “I don’t want to think about us, either.”
But more experts and policy makers are likely to have to start thinking about them soon. The cost of long-term acute care is substantial, about $26 billion a year in the United States, and by one estimate the number of patients in these facilities has more than tripled in the past decade to 380,000.
There are two reasons, said Dr. Judith Nelson, a critical care specialist at Mount Sinai Hospital.
The population is aging, increasing the chances of a catastrophic illness like blood sepsis or acute respiratory distress syndrome that eventually may land patients in a hospital like this one. And doctors are getting better at keeping people alive when they are in intensive care. The result is an increase in the number of highly dependent patients who survive the intensive care unit but must remain on a respirator. They cannot go home or to a rehabilitation facility. Many are too sick even for a nursing home. Long-term acute care is “where you go when you survive but you don’t recover,” Dr. Nelson said.
And yet this Connecticut hospital is not a place of unrelieved misery. The campus is leafy and green, and the windows are wide and filled with sunlight. Paintings by residents and local artists decorate the walls. On nice days patients can visit a landscaped garden along a path of paving stones and lined with respirator hookups.
Dedicated doctors and staff tend cheerfully to patients who require nearly constant care, some of whom are managing to make lives for themselves. Recently two patients with muscular dystrophy, both in wheelchairs, married in the courtyard outside. The bride was given away by her weeping father.
“It’s remarkable,” said Dr. John Votto, the hospital’s chief executive. “You are on a ventilator, you can’t move, you can’t walk, you can’t breathe. You and I would say, ‘Oh my God, you must have this terrible quality of life.’ But they really don’t. Honestly, many are quite happy.”
Photo
Tammy Bohmer, a nurse, assisting Murray Zack with telephone conversation with his son. The outlook for patients usually isn’t hopeful, but the hospital is not a place of unrelieved misery. Credit Richard Gershon for The New York Times
Often they arrive here because ordinary hospitals do not want to keep them. Reimbursement is tied to diagnosis and treatment, but most of these patients no longer need a diagnosis; they need treatment and care. Most start out being covered by Medicare, but when that benefit runs out — at 150 days — long-term-care hospitals either discharge the patients anyway or Medicaid usually takes over.
Medicare, concerned about the high price of long-term acute care hospitals, is trying to trim reimbursements. Nearly half of the $7.3 billion cut from its budget by the Affordable Care Act came from reductions in payments to these facilities. Medicare officials argue that perhaps these patients could stay in regular hospitals or nursing homes instead, and say it’s unclear whether care is better in long-term acute care hospitals.
But nobody knows what “better” means for these patients, and that makes it difficult to assess how well these facilities are operating.
“We don’t know how to measure quality,” said Dr. Jeremy Kahn, associate professor of critical care, medicine and health policy in the University of Pittsburgh School of Medicine. “The current Medicare quality measures are borrowed from I.C.U.s. Whether they apply in long-term acute care hospitals is unknown.”
The Hospital for Special Care is unusual because 70 percent of its patients are on Medicaid. Yet just 30 percent were on Medicaid when they were admitted, Dr. Votto said. Even with government support, many families are financially devastated when a relative lands in one of these hospitals.
The facility may be several hours from a family’s home, so relatives end up staying away from their jobs, living in hotels to be near a parent, child or spouse. Some deplete their life savings. “It’s a tragedy, a real tragedy,” said Dr. Christopher Cox, a critical care specialist at Duke University School of Medicine. “A heartbreaking situation.”
The road to a long-term acute care hospital often starts in an I.C.U. somewhere else when a doctor suggests placing a tube in a patient’s throat so he or she can be hooked up to a ventilator. “Once that happens, your future is not bright, unless you are quite young,” Dr. Nelson said.
Photo
A ceiling tile above a patient’s bed at the hospital was replaced by a scenic image. Credit Richard Gershon for The New York Times
Deciding to have a tracheotomy should be a difficult decision for family members, she added. But, she said, “people misunderstand — they think it is a sign of hope.” Few doctors discuss the likely consequences or the alternatives.
“It could be that physicians are not confident in their prognosis and therefore don’t want to share it, or it could be that physicians do share it and families don’t want to hear it,” said Dr. Shannon Carson, a critical care specialist at the University of North Carolina School of Medicine, who has studied what families expect when a relative enters a long-term acute care hospital.
But the likeliest reason for the disconnect, he said, is that families are initially dealing with I.C.U. physicians who are focused simply on keeping the patient alive: “They are discussing how the patient is doing today, not how they will be doing in six months,” he said.
Continue reading the main story Continue reading the main story
Continue reading the main story
The result is predictable, experts say.
“People are not prepared,” Dr. Nelson said. “There is one intervention after another. Ventilator, feeding tube, permanent feeding tube, permanent intravenous access. ‘Should we treat this infection?’”
The initial optimism soon vanishes after the patient arrives at the long-term acute care hospital. Some patients and their families eventually must confront an extraordinarily difficult question: When is it time to stop the interventions?
In one of their studies, Dr. Nelson and her colleagues telephoned people six months after they entered long-term acute care hospitals, intending to give them a brief set of questions to assess their mental functioning. But, they found, almost no one they called could respond to the telephone.
Photo
Dr. Paul Scalise, left, of the Hospital for Special Care, with Joy Franklin, a patient, and staff members. “People don’t want to think about us,” he said. Credit Richard Gershon for The New York Times
Dr. Cox and his colleagues have found that about half of the patients who enter these facilities are dead within a year, and most of the rest are in custodial care. Just 10 percent to 15 percent return to an independent life.
At the Hospital for Special Care, 100 patients, including babies and children, are on ventilators. Seventy-five of them, Dr. Scalise said, “are on ventilators forever.” That’s why there are hookups in most of the hallways.
But while many of these patients may occupy a frightening middle ground between death and the lives they once knew, some do find happiness. The children, some abandoned by their parents, gurgle happily in the hands of volunteers careful not the disturb their respirator hoses. The couple who recently were married, Chris Plum, 38, and Margaret Lavigne, 43, share a room crowded with medical equipment, attended at all hours by determined aides. They kiss each other good night before being lifted into separate hospital beds.
“Everybody wants ‘the One,’ ” said Ms. Lavigne. “I did not expect to find him here, of all places.”
Other patients face tougher choices. The man with A.L.S. knows he will never eat again, that he will never walk again. He knows that the little muscle movement he has left will go. But it is not easy to pick a day and decide that is the day you will die.
Dr. Scalise visits the patient, who signs and mouths the words that he does not want to live like this any longer. But Dr. Scalise wants to be certain the man is sure. He asks a psychologist, a psychiatrist and another doctor to talk independently to the patient about what he wants to do.
Dr. Scalise, the nurse and the respiratory therapist are haunted by that first difficult conversation. “He does not want to live here, and he does not want to die,” Dr. Scalise said. “There is no training that deals with any of this.”
The man waits a week, speaking with the other doctors, thinking about how hard it would be to leave his family, including four children, two of whom were still in college. Then he asks the hospital staff to disconnect the ventilator.
On Wednesday, Feb. 27, at 8 p.m., the man’s nurses began giving him intravenous medications to deeply sedate him. The next morning, they turned off his ventilator. The man’s family was gathered at his bedside. Death followed in about 20 minutes.
“It was very hard to lose him,” his wife said. “I think it took a lot of courage.”
A version of this article appears in print on June 24, 2014, on page D1 of the New York edition with the headline: Where Recovery Is Rare.
NEW BRITAIN, CONN. — Propped up in a hospital bed, a 75-year-old man with amyotrophic lateral sclerosis, or Lou Gehrig’s disease, must make an agonizing decision. Should he keep struggling until the illness inevitably kills him, dependent on a ventilator, unable to walk or eat or move? Or should he choose a day and a time to have the ventilator disconnected, and die?
The man, who asked not to be identified to protect his privacy, was a patient at the Hospital for Special Care here, one of 400 long-term acute care hospitals in the United States. These are no ordinary hospitals: Critically ill patients, sometimes unresponsive or in comas, may live here for months, even years, sustained by respirators and feeding tubes. Some, especially those recovering from accidents, eventually will leave. Others will be here for the rest of their lives.
These facilities often are tucked out of sight, and even many doctors do not know they exist. This one sits on the edge of a decaying industrial town.
“People don’t want to think about us,” said Dr. Paul Scalise, chief of medicine at the Hospital for Special Care. “I don’t want to think about us, either.”
But more experts and policy makers are likely to have to start thinking about them soon. The cost of long-term acute care is substantial, about $26 billion a year in the United States, and by one estimate the number of patients in these facilities has more than tripled in the past decade to 380,000.
There are two reasons, said Dr. Judith Nelson, a critical care specialist at Mount Sinai Hospital.
The population is aging, increasing the chances of a catastrophic illness like blood sepsis or acute respiratory distress syndrome that eventually may land patients in a hospital like this one. And doctors are getting better at keeping people alive when they are in intensive care. The result is an increase in the number of highly dependent patients who survive the intensive care unit but must remain on a respirator. They cannot go home or to a rehabilitation facility. Many are too sick even for a nursing home. Long-term acute care is “where you go when you survive but you don’t recover,” Dr. Nelson said.
And yet this Connecticut hospital is not a place of unrelieved misery. The campus is leafy and green, and the windows are wide and filled with sunlight. Paintings by residents and local artists decorate the walls. On nice days patients can visit a landscaped garden along a path of paving stones and lined with respirator hookups.
Dedicated doctors and staff tend cheerfully to patients who require nearly constant care, some of whom are managing to make lives for themselves. Recently two patients with muscular dystrophy, both in wheelchairs, married in the courtyard outside. The bride was given away by her weeping father.
“It’s remarkable,” said Dr. John Votto, the hospital’s chief executive. “You are on a ventilator, you can’t move, you can’t walk, you can’t breathe. You and I would say, ‘Oh my God, you must have this terrible quality of life.’ But they really don’t. Honestly, many are quite happy.”
Photo
Tammy Bohmer, a nurse, assisting Murray Zack with telephone conversation with his son. The outlook for patients usually isn’t hopeful, but the hospital is not a place of unrelieved misery. Credit Richard Gershon for The New York Times
Often they arrive here because ordinary hospitals do not want to keep them. Reimbursement is tied to diagnosis and treatment, but most of these patients no longer need a diagnosis; they need treatment and care. Most start out being covered by Medicare, but when that benefit runs out — at 150 days — long-term-care hospitals either discharge the patients anyway or Medicaid usually takes over.
Medicare, concerned about the high price of long-term acute care hospitals, is trying to trim reimbursements. Nearly half of the $7.3 billion cut from its budget by the Affordable Care Act came from reductions in payments to these facilities. Medicare officials argue that perhaps these patients could stay in regular hospitals or nursing homes instead, and say it’s unclear whether care is better in long-term acute care hospitals.
But nobody knows what “better” means for these patients, and that makes it difficult to assess how well these facilities are operating.
“We don’t know how to measure quality,” said Dr. Jeremy Kahn, associate professor of critical care, medicine and health policy in the University of Pittsburgh School of Medicine. “The current Medicare quality measures are borrowed from I.C.U.s. Whether they apply in long-term acute care hospitals is unknown.”
The Hospital for Special Care is unusual because 70 percent of its patients are on Medicaid. Yet just 30 percent were on Medicaid when they were admitted, Dr. Votto said. Even with government support, many families are financially devastated when a relative lands in one of these hospitals.
The facility may be several hours from a family’s home, so relatives end up staying away from their jobs, living in hotels to be near a parent, child or spouse. Some deplete their life savings. “It’s a tragedy, a real tragedy,” said Dr. Christopher Cox, a critical care specialist at Duke University School of Medicine. “A heartbreaking situation.”
The road to a long-term acute care hospital often starts in an I.C.U. somewhere else when a doctor suggests placing a tube in a patient’s throat so he or she can be hooked up to a ventilator. “Once that happens, your future is not bright, unless you are quite young,” Dr. Nelson said.
Photo
A ceiling tile above a patient’s bed at the hospital was replaced by a scenic image. Credit Richard Gershon for The New York Times
Deciding to have a tracheotomy should be a difficult decision for family members, she added. But, she said, “people misunderstand — they think it is a sign of hope.” Few doctors discuss the likely consequences or the alternatives.
“It could be that physicians are not confident in their prognosis and therefore don’t want to share it, or it could be that physicians do share it and families don’t want to hear it,” said Dr. Shannon Carson, a critical care specialist at the University of North Carolina School of Medicine, who has studied what families expect when a relative enters a long-term acute care hospital.
But the likeliest reason for the disconnect, he said, is that families are initially dealing with I.C.U. physicians who are focused simply on keeping the patient alive: “They are discussing how the patient is doing today, not how they will be doing in six months,” he said.
Continue reading the main story Continue reading the main story
Continue reading the main story
The result is predictable, experts say.
“People are not prepared,” Dr. Nelson said. “There is one intervention after another. Ventilator, feeding tube, permanent feeding tube, permanent intravenous access. ‘Should we treat this infection?’”
The initial optimism soon vanishes after the patient arrives at the long-term acute care hospital. Some patients and their families eventually must confront an extraordinarily difficult question: When is it time to stop the interventions?
In one of their studies, Dr. Nelson and her colleagues telephoned people six months after they entered long-term acute care hospitals, intending to give them a brief set of questions to assess their mental functioning. But, they found, almost no one they called could respond to the telephone.
Photo
Dr. Paul Scalise, left, of the Hospital for Special Care, with Joy Franklin, a patient, and staff members. “People don’t want to think about us,” he said. Credit Richard Gershon for The New York Times
Dr. Cox and his colleagues have found that about half of the patients who enter these facilities are dead within a year, and most of the rest are in custodial care. Just 10 percent to 15 percent return to an independent life.
At the Hospital for Special Care, 100 patients, including babies and children, are on ventilators. Seventy-five of them, Dr. Scalise said, “are on ventilators forever.” That’s why there are hookups in most of the hallways.
But while many of these patients may occupy a frightening middle ground between death and the lives they once knew, some do find happiness. The children, some abandoned by their parents, gurgle happily in the hands of volunteers careful not the disturb their respirator hoses. The couple who recently were married, Chris Plum, 38, and Margaret Lavigne, 43, share a room crowded with medical equipment, attended at all hours by determined aides. They kiss each other good night before being lifted into separate hospital beds.
“Everybody wants ‘the One,’ ” said Ms. Lavigne. “I did not expect to find him here, of all places.”
Other patients face tougher choices. The man with A.L.S. knows he will never eat again, that he will never walk again. He knows that the little muscle movement he has left will go. But it is not easy to pick a day and decide that is the day you will die.
Dr. Scalise visits the patient, who signs and mouths the words that he does not want to live like this any longer. But Dr. Scalise wants to be certain the man is sure. He asks a psychologist, a psychiatrist and another doctor to talk independently to the patient about what he wants to do.
Dr. Scalise, the nurse and the respiratory therapist are haunted by that first difficult conversation. “He does not want to live here, and he does not want to die,” Dr. Scalise said. “There is no training that deals with any of this.”
The man waits a week, speaking with the other doctors, thinking about how hard it would be to leave his family, including four children, two of whom were still in college. Then he asks the hospital staff to disconnect the ventilator.
On Wednesday, Feb. 27, at 8 p.m., the man’s nurses began giving him intravenous medications to deeply sedate him. The next morning, they turned off his ventilator. The man’s family was gathered at his bedside. Death followed in about 20 minutes.
“It was very hard to lose him,” his wife said. “I think it took a lot of courage.”
A version of this article appears in print on June 24, 2014, on page D1 of the New York edition with the headline: Where Recovery Is Rare.
Sunday, June 22, 2014
Beware of the medical-industrial complex
Dr. Arnold Relman, Outspoken Medical Editor, Dies at 91
By DOUGLAS MARTINJUNE 21, 2014
Photo
Dr. Arnold S. Relman in 1979 at The New England Journal of Medicine. He led it for 23 years. Credit Associated Press
Dr. Arnold S. Relman, who abandoned the study of philosophy to rise to the top of the medical profession as a researcher, administrator and longtime editor of The New England Journal of Medicine, which became a platform for his early and influential attacks on the profit-driven health care system, died at his home in Cambridge, Mass., on Tuesday, his 91st birthday.
His wife, Dr. Marcia Angell, said the cause was melanoma.
Dr. Relman and Dr. Angell filled top editorial posts at the journal for almost a quarter-century, becoming “American medicine’s royal couple,” as the physician and journalist Abigail Zuger wrote in The New York Times in 2012.
The couple shared a George Polk Award, one of journalism’s highest prizes, for an article in 2002 in The New Republic that documented how drug companies invest far more in advertising and lobbying than in research and development.
His extended critique of the medical system was just one facet of a long and accomplished career. Dr. Relman was president of the American Federation for Clinical Research, the American Society of Clinical Investigation and the Association of American Physicians — the only person to hold all three positions. He taught and did research at Boston University, the University of Pennsylvania, Oxford and Harvard, where he was professor emeritus of medicine and social medicine.
Early in his career, he did pioneering research on kidney function.
He was also editor of The Journal of Clinical Investigation, a bible in its field, and he wrote hundreds of articles, for both professional journals and general-interest publications. Days before he died, Dr. Relman received the galleys of his final article, a review of a book on health care spending for The New York Review of Books, to which he was a frequent contributor.
In a provocative essay in the New England journal on Oct. 23, 1980, Dr. Relman, the editor in chief, issued the clarion call that would resound through his career, assailing the American health care system as caring more about making money than curing the sick. He called it a “new medical-industrial complex” — a deliberate analogy to President Dwight D. Eisenhower’s warning about a “military-industrial complex.”
His targets were not the old-line drug companies and medical-equipment suppliers, but rather a new generation of health care and medical services — profit-driven hospitals and nursing homes, diagnostic laboratories, home-care services, kidney dialysis centers and other businesses that made up a multibillion-dollar industry.
“The private health care industry is primarily interested in selling services that are profitable, but patients are interested only in services that they need,” he wrote. In an editorial, The Times said he had “raised a timely warning.”
In 2012, asked how his prediction had turned out, Dr. Relman said medical profiteering had become even worse than he could have imagined.
His prescription was a single taxpayer-supported insurance system, like Medicare, to replace hundreds of private, high-overhead insurance companies, which he called “parasites.” To control costs, he advocated that doctors be paid a salary rather than a fee for each service performed.
Continue reading the main story
Dr. Relman recognized that his recommendations for repairing the health care system might be politically impossible, but he insisted that it was imperative to keep trying. Though he said he was glad that the health care law signed by President Obama in 2010 enabled more people to get insurance, he saw the legislation as a partial reform at best.
The health care system, he said, was in need of a more aggressive solution to fundamental problems, which he had discussed, somewhat philosophically, in an interview with Technology Review in 1989.
“Many people think that doctors make their recommendations from a basis of scientific certainty, that the facts are very clear and there’s only one way to diagnose or treat an illness,” he told the review. “In reality, that’s not always the case. Many things are a matter of conjecture, tradition, convenience, habit. In this gray area, where the facts are not clear and one has to make certain assumptions, it is unfortunately very easy to do things primarily because they are economically attractive.”
Dr. Relman edited The New England Journal of Medicine from 1977 to 2000. Founded in 1812, it is the oldest continuously published medical journal in the world, reaching more than 600,000 readers a week.
When he took the journal’s helm, interest in health news was booming, and newspapers and magazines competed to be first in reporting new developments. One policy he instituted was to ask general-interest publications not to disclose a forthcoming article in advance, a request almost always honored, albeit sometimes grudgingly.
He also began requiring authors to disclose any financial arrangements that could affect their judgment in writing about the medical field, including consultancies and stock ownership.
Dr. Relman and Dr. Angell met when she was a third-year student in one of his classes at Harvard Medical School. They published a paper on kidney disease together in The New England Journal of Medicine, then did not see each other for years.
After he became the journal’s editor, he asked her to come on board as an editor, which she did, abandoning her career as a pathologist. They began living together in 1994 — both were divorced by then — and married in 2009.
They became the ultimate medical power couple, not least because they were gatekeepers for one of the world’s most prestigious medical journals. Their outspoken views further distinguished them.
“Some have dismissed the pair as medical Don Quixotes, comically deluded figures tilting at benign features of the landscape,” Dr. Zuger wrote in The Times. “Others consider them first responders in what has become a battle for the soul of American medicine.”
Arnold Seymour Relman was born on June 17, 1923, in Queens (in an elevator, according to Dr. Angell) and grew up in the Far Rockaway neighborhood. His father was a businessman and avid reader who inspired his son’s love of philosophy. His mother nicknamed him Buddy, and friends called him Bud the rest of his life.
Continue reading the main story Continue reading the main story
Continue reading the main story
He skipped grades in school and graduated at 19 from Cornell with a degree in philosophy, but he chose not to pursue the field because it “seemed sort of too arcane,” his wife said. He earned a medical degree from the Columbia University College of Physicians and Surgeons at 22. His first marriage was to Harriet M. Vitkin.
In addition to Dr. Angell, he is survived by his sons, David and John, and a daughter, Margaret R. Batten, all from his first marriage; his stepdaughters, Dr. Lara Goitein and Elizabeth Goitein; six granddaughters; and four stepgrandsons.
Last June, Dr. Relman fell down a flight of stairs and cracked his skull, broke three vertebrae in his neck and broke more bones in his face. When he reached the emergency room, surgeons cut his neck to connect a breathing tube. His heart stopped three times.
“Technically, I died,” he told The Boston Globe.
He went on to write an article about his experience for The New York Review of Books, offering the unusual perspective of both a patient and a doctor.
“It’s both good and bad to be a doctor and to be old and sick,” he told The Globe.
“You learn to make the most of it,” he added. “Schopenhauer, the German philosopher, said life is slow death. Doctors learn to accept that as part of life. Although we consider death to be our enemy, it’s something we know very well, and that we deal with all the time, and we know that we are no different. My body is just another body.”
A version of this article appears in print on June 22, 2014, on page A23 of the New York edition with the headline: Dr. Arnold Relman, 91, Outspoken Medical Editor, Dies. Order Reprints|Today's Paper|Subscribe
By DOUGLAS MARTINJUNE 21, 2014
Photo
Dr. Arnold S. Relman in 1979 at The New England Journal of Medicine. He led it for 23 years. Credit Associated Press
Dr. Arnold S. Relman, who abandoned the study of philosophy to rise to the top of the medical profession as a researcher, administrator and longtime editor of The New England Journal of Medicine, which became a platform for his early and influential attacks on the profit-driven health care system, died at his home in Cambridge, Mass., on Tuesday, his 91st birthday.
His wife, Dr. Marcia Angell, said the cause was melanoma.
Dr. Relman and Dr. Angell filled top editorial posts at the journal for almost a quarter-century, becoming “American medicine’s royal couple,” as the physician and journalist Abigail Zuger wrote in The New York Times in 2012.
The couple shared a George Polk Award, one of journalism’s highest prizes, for an article in 2002 in The New Republic that documented how drug companies invest far more in advertising and lobbying than in research and development.
His extended critique of the medical system was just one facet of a long and accomplished career. Dr. Relman was president of the American Federation for Clinical Research, the American Society of Clinical Investigation and the Association of American Physicians — the only person to hold all three positions. He taught and did research at Boston University, the University of Pennsylvania, Oxford and Harvard, where he was professor emeritus of medicine and social medicine.
Early in his career, he did pioneering research on kidney function.
He was also editor of The Journal of Clinical Investigation, a bible in its field, and he wrote hundreds of articles, for both professional journals and general-interest publications. Days before he died, Dr. Relman received the galleys of his final article, a review of a book on health care spending for The New York Review of Books, to which he was a frequent contributor.
In a provocative essay in the New England journal on Oct. 23, 1980, Dr. Relman, the editor in chief, issued the clarion call that would resound through his career, assailing the American health care system as caring more about making money than curing the sick. He called it a “new medical-industrial complex” — a deliberate analogy to President Dwight D. Eisenhower’s warning about a “military-industrial complex.”
His targets were not the old-line drug companies and medical-equipment suppliers, but rather a new generation of health care and medical services — profit-driven hospitals and nursing homes, diagnostic laboratories, home-care services, kidney dialysis centers and other businesses that made up a multibillion-dollar industry.
“The private health care industry is primarily interested in selling services that are profitable, but patients are interested only in services that they need,” he wrote. In an editorial, The Times said he had “raised a timely warning.”
In 2012, asked how his prediction had turned out, Dr. Relman said medical profiteering had become even worse than he could have imagined.
His prescription was a single taxpayer-supported insurance system, like Medicare, to replace hundreds of private, high-overhead insurance companies, which he called “parasites.” To control costs, he advocated that doctors be paid a salary rather than a fee for each service performed.
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Dr. Relman recognized that his recommendations for repairing the health care system might be politically impossible, but he insisted that it was imperative to keep trying. Though he said he was glad that the health care law signed by President Obama in 2010 enabled more people to get insurance, he saw the legislation as a partial reform at best.
The health care system, he said, was in need of a more aggressive solution to fundamental problems, which he had discussed, somewhat philosophically, in an interview with Technology Review in 1989.
“Many people think that doctors make their recommendations from a basis of scientific certainty, that the facts are very clear and there’s only one way to diagnose or treat an illness,” he told the review. “In reality, that’s not always the case. Many things are a matter of conjecture, tradition, convenience, habit. In this gray area, where the facts are not clear and one has to make certain assumptions, it is unfortunately very easy to do things primarily because they are economically attractive.”
Dr. Relman edited The New England Journal of Medicine from 1977 to 2000. Founded in 1812, it is the oldest continuously published medical journal in the world, reaching more than 600,000 readers a week.
When he took the journal’s helm, interest in health news was booming, and newspapers and magazines competed to be first in reporting new developments. One policy he instituted was to ask general-interest publications not to disclose a forthcoming article in advance, a request almost always honored, albeit sometimes grudgingly.
He also began requiring authors to disclose any financial arrangements that could affect their judgment in writing about the medical field, including consultancies and stock ownership.
Dr. Relman and Dr. Angell met when she was a third-year student in one of his classes at Harvard Medical School. They published a paper on kidney disease together in The New England Journal of Medicine, then did not see each other for years.
After he became the journal’s editor, he asked her to come on board as an editor, which she did, abandoning her career as a pathologist. They began living together in 1994 — both were divorced by then — and married in 2009.
They became the ultimate medical power couple, not least because they were gatekeepers for one of the world’s most prestigious medical journals. Their outspoken views further distinguished them.
“Some have dismissed the pair as medical Don Quixotes, comically deluded figures tilting at benign features of the landscape,” Dr. Zuger wrote in The Times. “Others consider them first responders in what has become a battle for the soul of American medicine.”
Arnold Seymour Relman was born on June 17, 1923, in Queens (in an elevator, according to Dr. Angell) and grew up in the Far Rockaway neighborhood. His father was a businessman and avid reader who inspired his son’s love of philosophy. His mother nicknamed him Buddy, and friends called him Bud the rest of his life.
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He skipped grades in school and graduated at 19 from Cornell with a degree in philosophy, but he chose not to pursue the field because it “seemed sort of too arcane,” his wife said. He earned a medical degree from the Columbia University College of Physicians and Surgeons at 22. His first marriage was to Harriet M. Vitkin.
In addition to Dr. Angell, he is survived by his sons, David and John, and a daughter, Margaret R. Batten, all from his first marriage; his stepdaughters, Dr. Lara Goitein and Elizabeth Goitein; six granddaughters; and four stepgrandsons.
Last June, Dr. Relman fell down a flight of stairs and cracked his skull, broke three vertebrae in his neck and broke more bones in his face. When he reached the emergency room, surgeons cut his neck to connect a breathing tube. His heart stopped three times.
“Technically, I died,” he told The Boston Globe.
He went on to write an article about his experience for The New York Review of Books, offering the unusual perspective of both a patient and a doctor.
“It’s both good and bad to be a doctor and to be old and sick,” he told The Globe.
“You learn to make the most of it,” he added. “Schopenhauer, the German philosopher, said life is slow death. Doctors learn to accept that as part of life. Although we consider death to be our enemy, it’s something we know very well, and that we deal with all the time, and we know that we are no different. My body is just another body.”
A version of this article appears in print on June 22, 2014, on page A23 of the New York edition with the headline: Dr. Arnold Relman, 91, Outspoken Medical Editor, Dies. Order Reprints|Today's Paper|Subscribe
Purgatory
Randy was first scheduled in 2010 to go to GF Strong for rehab but instead at the last minute he was sent to live at George Pearson Centre in purgatory. Why was the direction of his treatment changed?
Saturday, June 21, 2014
Coerced Sterilization in Virginia
From: Bioedge June 2014
A petty criminal sentenced to become sterile. Commentary from Bioedge:
Perhaps Ms White lacks a sense of history, or she would have sensed the irony of compulsory sterilization in Virginia. In 2002, the 75th anniversary of a notorious Supreme Court decision, Buck v. Bell, Virginia Governor Mark Warner publicly apologized for the state’s past involvement in eugenics. He said, "The eugenics movement was a shameful effort in which state government never should have been involved."
Carrie Buck was a young woman whom the commonwealth of Virginia wanted to sterilise because she came from bad stock. The case went all the way to the US Supreme Court, which ruled, in an 8-1 decision, against Ms Buck. The majority ruling was written in 1927 by the legendary Oliver Wendell Holmes Jr, whose imperishable argument was:
“It is better for all the world, if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. The principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes. Three generations of imbeciles are enough. "
After nearly a century, perhaps the commonwealth of Virginia has come full circle in its attitude toward eugenics. Except that now, two generations seem to be enough.
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A petty criminal sentenced to become sterile. Commentary from Bioedge:
Perhaps Ms White lacks a sense of history, or she would have sensed the irony of compulsory sterilization in Virginia. In 2002, the 75th anniversary of a notorious Supreme Court decision, Buck v. Bell, Virginia Governor Mark Warner publicly apologized for the state’s past involvement in eugenics. He said, "The eugenics movement was a shameful effort in which state government never should have been involved."
Carrie Buck was a young woman whom the commonwealth of Virginia wanted to sterilise because she came from bad stock. The case went all the way to the US Supreme Court, which ruled, in an 8-1 decision, against Ms Buck. The majority ruling was written in 1927 by the legendary Oliver Wendell Holmes Jr, whose imperishable argument was:
“It is better for all the world, if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. The principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes. Three generations of imbeciles are enough. "
After nearly a century, perhaps the commonwealth of Virginia has come full circle in its attitude toward eugenics. Except that now, two generations seem to be enough.
.
Tuesday, June 17, 2014
Blog2Print
As it is difficult to read and put in context my blog posts, I can print copies of my posts in paper form (soft cover book). This professional service is provided by Blog2Print. The cost is $50.00, so if you want a printout, just send me a cheque or money order. My Blog2Print book is easier and thus more interesting to read and refer to. The cost of the Blog2Print book is its cost and I will send you a photocopy of the Blog2Print invoice. .
Friday, June 13, 2014
13 June 2014 Two Month Anniversary
Today is the two month anniversary of Randy's death. I am in terrible grief. It isn't because he died but rather the way he died. Vancouver Coastal Health treated us like we were less than human.
Only the sociopaths knew what was good for Randy and I. No one showed any compassion for his death; no one even went to his memorial service at George Pearson Centre. His home. I wasn't even invited as if I was a what I do not know.
All I see from the nursing staff from GPC and also VGH is indifference; not a kind word; or even a small tear. Nothing.
If I didn't have a BC supreme court order to be with Randy should he be in intensive care, VCH would have got away with its threat of me never being with him at his bedside when he died. Thank you Linda Rose.
I still do not know what he died from. I asked for an autopsy but it never came. Why did they keep fighting: Roberts and Dunne about where Randy should go. Roberts did not want him at VGH as his care was too costly and neither did Dunne want him at GPC as GPC did not have personnel to properly look after Randy. Since he would never get well I suspect they put a futile order on him and let him die. VCH does not have a policy re futile, a doctor just decides and that is it.
Forget about a doctor talking to a family, he will only talk to a family if he knows the family will agree with him. Randy was in no pain, he just wanted to live.
And to make it worse most of this had nothing to do with Randy but everything to do with me and my behavior as defined by a star chamber The star chamber was first defined to me as the team of doctors and techs who looked after Randy however when I asked the team one by one over the years if they were aware of my banning all of them negated except for Tanu, Marion, and Bob Chapman. I believed that no majority would have denied me access. And the majority of the team didn't as they did not know what was going on. And of course the residents and visitors knew nothing of the banning as well. VCH are so used to banning visitors and they never coming back and there is no effective way of complaining as the complainer is always at fault. The cause for the banning is never made public. The person just goes away. I remember asking what did I do wrong and I was told you knew what you did. No, I do not know what I did to cause Randy such psychological pain.
GPC has so much control over its residents that GPC reads every single piece of mail as well as every single email that goes in and out of GPC. As for cameras they are all over the place except viewing the resident in his bed so that any wrongdoing done by the nurses are not recorded. And nurses report everything you say to management. And VGH has "baby monitors" so they can hear everything that is going on and they might even be recording everything.
I am so sorry Randy. I should have fought harder for you. You trusted me and I failed you.
.
Only the sociopaths knew what was good for Randy and I. No one showed any compassion for his death; no one even went to his memorial service at George Pearson Centre. His home. I wasn't even invited as if I was a what I do not know.
All I see from the nursing staff from GPC and also VGH is indifference; not a kind word; or even a small tear. Nothing.
If I didn't have a BC supreme court order to be with Randy should he be in intensive care, VCH would have got away with its threat of me never being with him at his bedside when he died. Thank you Linda Rose.
I still do not know what he died from. I asked for an autopsy but it never came. Why did they keep fighting: Roberts and Dunne about where Randy should go. Roberts did not want him at VGH as his care was too costly and neither did Dunne want him at GPC as GPC did not have personnel to properly look after Randy. Since he would never get well I suspect they put a futile order on him and let him die. VCH does not have a policy re futile, a doctor just decides and that is it.
Forget about a doctor talking to a family, he will only talk to a family if he knows the family will agree with him. Randy was in no pain, he just wanted to live.
And to make it worse most of this had nothing to do with Randy but everything to do with me and my behavior as defined by a star chamber The star chamber was first defined to me as the team of doctors and techs who looked after Randy however when I asked the team one by one over the years if they were aware of my banning all of them negated except for Tanu, Marion, and Bob Chapman. I believed that no majority would have denied me access. And the majority of the team didn't as they did not know what was going on. And of course the residents and visitors knew nothing of the banning as well. VCH are so used to banning visitors and they never coming back and there is no effective way of complaining as the complainer is always at fault. The cause for the banning is never made public. The person just goes away. I remember asking what did I do wrong and I was told you knew what you did. No, I do not know what I did to cause Randy such psychological pain.
GPC has so much control over its residents that GPC reads every single piece of mail as well as every single email that goes in and out of GPC. As for cameras they are all over the place except viewing the resident in his bed so that any wrongdoing done by the nurses are not recorded. And nurses report everything you say to management. And VGH has "baby monitors" so they can hear everything that is going on and they might even be recording everything.
I am so sorry Randy. I should have fought harder for you. You trusted me and I failed you.
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Wednesday, June 11, 2014
Grieving and Euthanasia
Monday, June 9, 2014
Euthanasia threatens the lives of the grieving.
My son Frank died in a car accident in 1997. He was 19. He was my oldest child, my only son (I have 3 daughters).
In the first year after his death, I wanted to die. I wanted the agony and pain I was feeling to end. Death seemed to be the only way. Yet, I did not REALLY want to die. I wanted the PAIN to die. The second year after his death was even worse. It was not until the third year that I started to heal.
I became involved in Bereaved Families of Ontario in Kingston Ontario, and I soon realized that almost all mother's feel the same way. I met a mom - both of her daughters were killed on the same day in a car accident (they were 19 and 16) and she had no other children. We hear stories similar to this often on the news.
This pain of the bereaved parent is felt physically, emotionally and spiritually. Some parents build shrines in their homes for their lost child, and never really heal. Some are mad at God.
I felt torn apart, physically. I hurt all over. It was as if my body was rebelling against Frank's death. Emotionally I was a mess. It doesn't matter if you have other children when one of them dies. Sometimes, the other children suffer more because at a time when they need you the most, you are least available to them.
I can see the problem of euthanasia extending its deathly grip on the bereaved. What about the widows and widowers who can't bear to live without their spouse?
We need our governments to put more money into programs to help the bereaved before this is another group targeted by the euthanasia movement.
Bill 52 which was just passed in Quebec frightens me.
Sincerely,
Caroline Yates
Kingston, Ontario
Posted by Alex Schadenberg at 4:44 PM
Monday, June 9, 2014
A neighbour
I just spoke to a man who told me a story about his mother-in-law who was diagnosed with an enlarged heart and was dying. It was in the days when family members could decide would is best for their members and he quickly took her out of the hospital to her home where she continued to live for one year more. Another friend of mine took her grandmother out of the hospital who also had a serious heart condition and she lived three more years. So how many stories like this are out there.
Sunday, June 8, 2014
Engagement
I just discovered a Carlton card addressed to me by Randy: it says
Love. Everthing beautiful begins with love. May the two of us be more in love with ever passing day. and may everthing that makes you happy always come our way. We are engaged.
He gave me a ring three sizes too large and he said he would desize it. I do not know what happened to the ring but I am sure I will eventually find it. It had a wide gold band and a little diamond on it. He and his friend picked it out for me. They were so delighted in their purchase.
The card is one memory I can keep.
Tuesday, June 3, 2014
Post from December 2 2012
So what happened a year later ... why did staff at GPC attack me and cause a total banning of me at GPC and get the Public Trustee involved. The Ethics Committee did nothing. Randy got sick after December 23 2012 and spent Christmas at St. Pauls....GPC then started to ration his treatment and kept labelling him DNR even after Randy's lawyer said he wanted FULL CODE.
Sunday, December 2, 2012
Things are a bit better at GPC....
Things are getting a bit better for me with Randy now that I am allowed to enter Ward 2 and stay with Randy for one-half hour sometimes it is extended to one hour. If he doesn't feel up to getting up I make sure he is comfortable, we chat a bit, and I make sure his television is on.
I do not have to take my valium any more as I access George Pearson Centre without anticipation of the stress of waiting and waiting and waiting for staff to bring Randy to the visitor's room. I was so intiminated that I could not speak to anyone for the fear that I would then be subject to a report that I was combative and agressive.
Now still under security of course I can go down to his open ward bed and if he wants to go to my place or to Oakridge for a few hours, I help him get dressed and we are off. I recently purchased him a $80,.00 rain cape that engulfs him while he is in his wheel chair outside. He also wears a Steelers hat. I purchased him a Steelers jacket for his birthday on December 10 2012 which I know will make him happy. He is a devote Steelers fan.
The same is when I return. I call 4777 Paladin Security on my arrival. They immediatley escort me down to his bed and watch me and I spend a few minutes sometimes a 1/2 hour to make sure Randy is comfortable. There is no problem; no residents are shrieking that they are afraid of me. I am not even noticed by the other residents.
Randy of course is more relaxed as he knows that I am looking after him at his bedside. Finally I am somewhat comfortable with this arrangement but of course I would prefer 24/7 access to him like other family members have to their loved ones.
I am hoping to access the ethics committee for a ruling to say a two year ban based on staff and visitors who have nothing else to do but target a 70 year old lady and bully her until she had a verbal outburst with staff over giving a stuff toy to a resident is unreasonable. The LPN grabbed it out of my hand and he told me the resident did not need it and ripped it from my hands.He did not ask the resident and the resident to my mind was disturbed by his behavior. Since he could not talk I had to defend my kindness. It was a large stuffed toy. And after two years the LPN is till working there making decisions for residents. The Santa Clause stuffed toy remained for months in the nurses station.
I suspect only to annoy me.
Sunday, June 1, 2014
I am so sorry.
Randy, I am so sorry that I didn't try hard enough to save you. I am so very sorry. I could have save you for a few more months or maybe a year I do not know but VCH forcing me from your treatment and not seeing you and not being able to talk to staff I did not know what they were doing to you to keep you alive as long as possible.
This afternoon a friend of Randy's took me to Canada Tire to purchase plastic buckets so I can store all my/Randy's possessions. Rearranging everything and repacking everything should take me a few days. I just can't throw any of Randy's belongings out yet. it is too soon.
I hope all those that were party to what happen on October 22 2013, November 18, 2013, December 26, 32103, and the first week of April 13 2014 and January 29 2014 are feeling remorse for what they did. All of them should be investigated and moved to no human contact duty.
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